The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
Around 25 years ago, I met the Balinese anthropologist and psychiatrist, Dr. Luh Ketut Suryani. She went on to establish the Suryani Institute for Mental Health in 2005, because, she said, “A large number of mentally ill people in Bali are essentially abandoned, permanently kept under restrains, chained or in makeshift cages by their families, or community (pasung).”
Indonesia spends less than 1 percent of its total health budget to mental health, uncommonly low even compared with other lower middle-income countries. It has only about 700 trained psychiatrists, roughly one for every 350,000 citizens.
Drs. Nova and Suryani have devoted their lives to improving the care and living conditions for Indonesia’s mentally ill. Pause for a moment to honor these two visionary women.
Dr. Luh Ketut Suryani
Dr. Nova Riyanti Yusuf
Here is a German language You Tube on "Bali's Dark Side." (Unfortunately, I can't find a copy with English subtitles, but the film can be viewed and appreciated even with the German narration.)
New findings about schizophrenia rekindle old questions about genes and identity. Annals of Science The New Yorker March 28, 2016 By Siddhartha Mukherjee
Mukherjee, the author of "The Emperor of All Maladies, has a personal interest in schizophrenia, hence the title: "Runs in the Family." This lucid New Yorker essay takes us from a "lunatic home" in Calcutta where his cousin resides to that sterile labs of prestigious research institutes whose scientists are teasing out the fascinating and complex genetics of mental illness.
While this is a long article, it is worth the effort and is available free full text.
"In every corner of the world, there are people who are flagrantly ill, people who mutter to invisible others and box at the air. But because the cultural texture is different in different settings, the experience of madness can be quite different, too. That is true even of such a blunt assault on human feeling as homelessness."
This is a profound Op-Ed peice by the anthropologist T.M. Luhrmann. If you are interested in mental health, homelessness and cultural differences in care you will find much in Luhrmann's "Where Homeless Meets Crazy." Among other things, Luhrmann compares the approach to the homeless in Chennai, India and Chicago.
This is a photo of Banyan, an Indian NGO, that, since 1993, has been an integral part of the chain of care for people with mental illness in Chennai. Their projects have changed the lives of over 5,000 people by providing services to support them in reaching their definition of recovery. They have taken over 1500 homeless women off the streets and started the rehabilitation process.
He was there every day, Looking at her from the other side of the window, Smiling at her as she handed over his little green pill. He wasn’t that old and she wasn’t that young; Neither had ever married. She was a psychiatric nurse’s aide who understood the inmates Because she had been abused as a child, pulling into herself To avoid punishment. He was there because he had been bullied as a little boy, Making it a habit of staying away from the big guys who could Beat him up. Now, they were adults, albeit imperfect ones, who Occasionally would sit together on her coffee breaks And tell light-hearted jokes. And forget their pain for a while. Their shrink had suggested they might have a lot in common. And truth be told, it had occurred to both of them.
One day, he was not at the window. On her break she sought him out. In his room, the bed was stripped. His toiletries and clothes were gone. Where was he, she wondered? She asked the nurses. They answered in soft voices with hooded eyes. They said they didn’t know. The next day in the obituary column she found his name. She went to the funeral with the little cup and a pillbox in her purse. After service was over, she pulled out the familiar little green pill, the one she had given him every day, and dropped it in the coffin.
Author Bio: Madelyn D. Kamen, D.P.H. is a free-lance writer and the founder of a document development and management-consulting firm. Prior to establishing this company, she was an associate dean and professor at the University of Texas Health Science Center at Houston. Kamen holds masters and doctorate degrees in public health. She has served on numerous boards in the community, particularly in the areas of women and children’s health and welfare.
T.M. Lurhmann is an anthrolologist, psychological anthropologist and essayist. Much of what she writes is prescient. Her recent piece, Redefining Mental Illness, in the Sunday, January 18, 2015 NY Times gives one much to contemplate. Here are some extracts, reordered for clarity.
"Mental and behavioral problems are the biggest single cause of disability on the planet. In low- and middle-income countries, about four of five of those disabled by these illnesses do not receive treatment for them. The World Health Organization estimates that one in four people will have an episode of mental illness in their lifetime."
"Diagnoses were neither particularly useful nor accurate for understanding the brain, and should no longer be used to guide research."
"The implications are that social experience plays a significant role in who becomes mentally ill, when they fall ill and how their illness unfolds. We should view illness as caused not only by brain deficits but also by abuse, deprivation and inequality, which alter the way brains behave. Illness thus requires social interventions, not just pharmacological ones."
"One outcome of this rethinking of mental illness could be that talk therapy will regain some of the importance it lost when the new diagnostic system was young. And we know how to do talk therapy. That doesn’t rule out medication: while there may be problems with the long-term use of antipsychotics, many people find them useful when their symptoms are severe."
by Madeline Halpert and Eva Rosenfeld, NY Times, May 21, 2014 The authors of this NY Times Opinion piece are managing editors at their high school newspaper in Michigan.
"Most of our closest friends didn’t know that we struggled with depression. It just wasn’t something we discussed with our high school classmates. We found that we both had taken Prozac only when one of us caught a glimpse of a prescription bottle in a suitcase during a journalism conference last November. For the first time, we openly discussed our feelings and our use of antidepressants with someone who could relate. We took a risk sharing our experiences with depression, but in our honesty, we found a support system. We knew we had to take the idea further."
To Cure Sometimes, To Relieve Often, To Comfort Always
Photo taken from "The Raw Story."
Shaving William is something like performing surgery, and when the weather permits, our back porch becomes our operating room.
So begins "Caring for William," a recent New England Journal of Medicine essay by Robert Jones. It will resonate with many of you for some time to come.
Robert Jones is an unusual medical student. He has chosen to divide his life between two very different worlds: a hospital, where I'm a medical student, and a homeless shelter, where I live and work... the boundaries often blur...
The New England Journal of Medicine's articles are often stodgy, pedantic and dense. Occasionally, a piece blazes with poignant insights. Caring for William is one of these. Because this link may not work for you since most NEJM articles are not free open-access, I have provided access to the essay here: Download Caring for William (but I will remove it in three days, so as not to incur the wrath of NEJM). If you want to read it later, contact me and I'll send you a pdf (it's the equivalent of a photocopy and should be okay with the publisher).
Jonah Zuflacht, a first year medical student at Columbia P&S has this comment: "Robert Jones' essay artfully portrays his relationship with a schizophrenic, homeless man. It serves as both a window into the absurd nature of the system in which he (and other soon-to-be physicians) will practice and a reminder of what drew many of us into medicine to begin with."
Minds on the Edge: Facing Mental Illness is a multi-platform media project that explores severe mental illness in America. The centerpiece of the project is a television program that premiered on PBS stations in October 2009. This video component is part of a national initiative that includes an extensive web site and an ambitious strategy to engage citizens, professionals in many fields, and policy makers at all levels of government. The goal is to advance consensus about how to improve the kinds of support and treatment available for people with mental illness.
Susan Rose, from North Adams, Massachusetts, alerted us to this excellent PBS forum. She writes: "As a person who has struggled with a mental illness for decades, I found this 2009 video compelling. The Supreme Court justice Stephen Breyer and Nobel Prize winning neuroscientist Eric R Kandel were just two of the speakers. I wish I could share this with the people closing Greylock Pavilion, our inpatient mental health unit in North Adams, Massachusetts. Everyone needs to listen to the discussion on this video. The situation is worsening because nationally many psychiatric units are closing their doors for financial reasons. The consequences of these closings will be devastating to mental health patients, their families, and the communities they served. The pain of mental illness affects everyone. The cost saved by shutting down mental health units will be offset by an increased rate of incarceration, as patients are forced into jails because there is no other place for them to go."
When Robert Gupta was caught between a career as a doctor and as a
violinist, he realized his place was in the middle, with a bow in his
hand and a sense of social justice in his heart. He tells a moving story
of society’s marginalized and the power of music therapy, which can
succeed where conventional medicine fails.
“For those living in the most dehumanizing conditions … music offers a chance for them to transcend the world around them, to remember that they still have the capacity to experience something beautiful.” Robert Gupta
TED Introduction: "Sherwin Nuland was a practicing surgeon for 30 years and treated more than 10,000 patients. Now he is an author and speaker on topics no smaller than life and death, our minds, our morality, aging and the human spirit.
In this TED talk, Nuland discusses the development of electroshock therapy as a cure for severe, life-threatening depression -- including his own. It’s a moving and heartfelt talk about relief, redemption and second chances." Well worth listening to.